26th September 2014, Volume 127 Number 1403

Alexandra Macmillan, Rhys Jones, Hayley Bennett

Climate change is arguably the defining health issue of our time, and 10 New Zealand health organisations have recently come together to issue a joint Call for Action on Climate Change and Health for New Zealand.1

Climate change’s prominence as a mainstream public health concern is evident in the many health-focused events that took place at the Climate Summit in New York this week. The summit was convened by the UN Secretary General and attended by over 120 heads of state, as well as health leaders including the US Surgeon General, Editor-in-Chief of the Lancet and the World Health Organization. In conjunction with the Climate Summit, civil society protests calling for urgent global action have been held across the globe, involving hundreds of thousands in a People’s Climate March.

Ahead of this Summit, the World Health Organization held an inaugural conference at its headquarters in Geneva to raise the profile of climate change as a crucial and urgent public health issue. The Director General of the World Health Organization, Dr Margaret Chan, stated: “[t]he evidence is overwhelming: climate change endangers human health. Solutions exist and we need to act decisively to change this trajectory.”2

This week the World Health Organization also released a new quantitative risk assessment of the global effects of climate change. A very limited subset of causes of death in the 2030s and 2050s was included.3 In 2030, 250,000 extra deaths per year are projected, with a sharply increasing burden of mortality attributable to heat exposure. This is an extremely conservative estimate of the adverse impacts on mortality of climate change, since major pathways of health impact could not be accounted for using current methods, such as via economic damage, major weather events and water scarcity. The likely step changes caused by crossing ecological and social thresholds were also not able to be modelled.

Also in association with the New York Climate Summit, the British National Health System has issued a collective statement of intent to deliver climate friendly health services into the future. The joint statement is the first example of one country’s health sector committing to tackle climate change.4

It is within this context that 10 New Zealand health organisations representing doctors, nurses, midwives and medical students, have recently come together to issue a joint Call to Action on Climate Change and Health for New Zealand. The groups include the New Zealand College of Public Health Medicine, The Australasian College for Emergency Medicine, The New Zealand Nurses Organisation, The New Zealand College of Midwives, The Public Health Association of New Zealand, The Health Promotion Forum, OraTaiao: The NZ Climate and Health Council, Medical Students for Global Awareness, The New Zealand Medical Students’ Association and the Auckland University Medical Students’ Association.1

In the Call to Action these organisations highlight human-caused climate change as an increasingly serious and urgent threat to health and health equity in New Zealand, as well as worldwide.5–11 The Call to Action also emphasises that rapid and effective action to reduce greenhouse gases in New Zealand represents an opportunity to improve health and equity in this country with the right policies.8,11,12

Health threats from climate change in New Zealand include direct impacts (e.g. from high temperatures and other extreme weather events); biologically-mediated impacts (e.g. changing patterns of infectious disease, global rises in food prices impacting on nutrition); and socially-mediated impacts (e.g. loss of livelihoods, forced migration, and increased risk of conflict).8–11 Māori, Pacific peoples, children, elderly and low income people are highlighted as those that are likely to be worst affected by climate health impacts.8–11

But opportunities to improve health and equity through climate action are also emphasised in the Call to Action.5,6,8,11 Three particular policy areas hold promise for optimising health and climate co-benefits. Firstly, more walking, cycling and public transport reduces greenhouse gas (GHG) emissions, increases physical activity, and can reduce health-damaging air pollution and road traffic injuries.5,6,11,12

Secondly, healthy diets that include more plants and fewer animal products could reduce agricultural GHG emissions, whilst also reducing cancer and heart disease across the New Zealand population.11,12,13 Thirdly, improving housing energy efficiency can reduce illnesses associated with cold, damp home environments (e.g. childhood asthma and chest infections which are leading causes of hospital admissions, particularly for Māori and Pacific children), whilst also cutting GHG emissions associated with home heating.11,14

The Call to Action highlights that these health co-benefits could reduce leading causes of death and illness in New Zealand, such as cardiovascular disease, respiratory disease, cancers and diabetes, with large cost savings to the health sector and society as a whole.6,8,11

The health professional groups are careful to point out in the Call to Action that measures to address climate change have the potential to widen or reduce existing health inequities, depending on design and implementation. Avoiding a disproportionate impact on low income groups and instead ensuring that co-benefits reduce social and health inequities will require careful policy design, for example by recycling carbon penalty revenue back into supporting low income households.15

The Call to Action makes a number of specific recommendations. It calls for a rapid, whole-of-society, transition to a low GHG-emitting nation in New Zealand, designed to make the most of opportunities for health and to create a fairer society. It also calls for the health sector to plan for the health impacts of climate change, and to show leadership in reducing greenhouse gas emissions – as other health systems (such as the British National Health System) are already doing. Measures that prioritise and protect groups likely to be worst affected by the health impacts of climate change are highlighted as essential; and Health Impact Assessment (HIA) is suggested as a tool to assist the planning of key climate-relevant policies in New Zealand.

The Call to Action highlights that no country can solve climate change singlehandedly, and that without taking rapid and sufficient action itself, New Zealand cannot effectively press for global emissions reductions in the interests of health protection. Thus the health groups specify that national emissions reduction targets in New Zealand of 80–95% by 2050 are needed, consistent with Intergovernmental Panel on Climate Change (IPCC) evidence and with our responsibilities as a developed nation with high per capita greenhouse gas emissions.

The 10 health organisations supporting the Call to Action also point out that New Zealand, as part of the Pacific region, will need to demonstrate leadership in protecting and promoting health in the climate-vulnerable Pacific region.

As 400,000 people hit the streets in New York for the ‘People’s Climate March’ on the opening day of the UN Climate Summit (and thousands more in 150 countries around the world), it is clear that people everywhere are making the links between climate change, human health, and survival. The ‘People’s Climate March’ is the largest climate protest in history and the largest social demonstration of the last decade.

The New Zealand health sector voice needs to join those voices being raised internationally – in other health systems, international medical journals and world health authorities – to make climate change a mainstream public health issue in New Zealand. The Call continues to be open to all health professional organisations in New Zealand to join. Together we must continue to press for urgent action to reduce the serious risks we face, and to seize the opportunities to improve health.

Author Information

Alexandra Macmillan, Public Health Medicine Specialist and Senior Lecturer in Environmental Health, Department of Preventive and Social Medicine, University of Otago Dunedin, and Acting Co-convenor of OraTaiao: The NZ Climate and Health Council; Rhys Jones (Ngāti Kahungunu), Public Health Physician and Senior Lecturer, Te Kupenga Hauora Māori, the University of Auckland, and Co-convenor of OraTaiao; Hayley Bennett, Public Health Medicine Specialist, Rotorua, and Coordinator of OraTaiao.

Correspondence

Alex Macmillan, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.

Correspondence Email

alex.macmillan@otago.ac.nz

Competing Interests

Nil.

References

1. Climate Change and Health. Health Professionals Joint Call For Action, September 2014. http://www.orataiao.org.nz/Joint+call+to+action

2. Speech by Dr. Margaret Chan, Director General of the World Health Organization. World Health Organisation Conference on Health and Climate, Geneva, August 27-29 2014. http://www.who.int/globalchange/mediacentre/events/climate-health-conference/en/

3. World Health Organization. Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva, World Health Organization, 2014. http://www.who.int/globalchange/publications/quantitative-risk-assessment/en/

4. UN Climate Summit Cross System Statement. Sustainable Development Unit, NHS and Public Health England. http://www.sduhealth.org.uk/policy-strategy/engagement-resources/un-climate-summit.aspx

5. Smith KR, Woodward A, Campbell-Lendrum D, Chadee D, Honda Y, et al. Human Health: Impacts, Adaptation, and Co-benefits. In: Climate Change 2014: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Field CB, Barros VR, Mastrandrea MD, Mach KJ, et al. (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, 2014. http://ipcc-wg2.gov/AR5/images/uploads/WGIIAR5-Chap11_FGDall.pdf

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11. New Zealand College of Public Health Medicine. Policy Statement on Climate Change. Wellington: New Zealand College of Public Health Medicine, 2013. http://www.nzcphm.org.nz/media/74098/1._nzcphm_climate_change_policy__final_comms_version2_.pdf

12. Haines A, McMichael AJ, Smith KR et al. Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers. Lancet. 2009;374:2104-14. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61759-1/fulltext  

13. Wilson N, Nghiem N, Ni Mhurchu C, Eyles H, Baker MG, Blakely T. Foods and dietary patterns that are healthy, low-cost, and environmentally sustainable: a case study of optimization modeling for New Zealand. PLoS ONE. 2013;8:e59648. doi:10.1371/journal.pone.0059648. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0059648

14. Howden-Chapman P, Matheson A, Viggers H et al. Retrofitting houses with insulation to reduce health inequalities: results of a clustered, randomised trial in a community setting. BMJ. 2007;334:460-464. http://www.bmj.com/content/334/7591/460

15. Dhar D, Macmillan A, Lindsay G, Woodward A. Carbon pricing in New Zealand: implications for public health. NZ Med J. 2009;122:105-15. http://www.nzma.org.nz/__data/assets/pdf_file/0006/17799/Vol-122-No-1290-27-February-2009.pdf